Author Picture

Defense Strategies to Prevent a Medical Fraud Investigation

If you are facing a federal health care fraud investigation, your highest priority must be to put a stop to the investigation before it leads to criminal charges. Depending on the conditions involved, there are several defense strategies at your disposal to prevent a medical fraud investigation.

As a health care professional practicing in the United States, you are at risk of being targeted by the federal government. Even though you have dedicated your career to fulfilling the medical needs of others, because of the rampant abuse of the Tricare, Medicaid, and Medicare systems, the government automatically perceives you as a possible offender.

Nowadays, health care fraud investigations are routine. Whether they are caused by a whistleblower’s allegations in a qui tam lawsuit or triggered by a “fee-for-service” audit, the examinations can be expensive, disruptive, and invasive. Investigations can result in severe punishments and penalties, up to and including federal imprisonment and criminal fines.

Safeguarding Your Health Care Practice or Business During a Federal Medical Fraud Investigation

Do you know what you need to do to protect yourself and your health care practice or business against criminal charges in the event of a federal medical fraud investigation? Below are several proven defensive strategies:

1. Stop the Government in Its Tracks

When you discover that you are under investigation, the U.S. Department of Justice (DOJ), Office of Inspector General (OIG), and numerous other federal organizations might already be investigating you intensively. To decelerate the investigation and prevent the government agencies from filing charges before you have an opportunity to respond, you must intervene in the investigation. What does intervening involve? At Hasson Law Group LLP, we use extensive knowledge in federal medical fraud investigations to effectively communicate with prosecutors and agents involved, decipher the nature of the investigation (I.e., criminal or civil), and assure them that there is more than one narrative to consider. Once the government acknowledges our presence, the process decelerates, and you are granted the opportunity to begin the implementation of strategic defenses.

2. Tip the Scales in Your Favor

In the usual medical fraud investigation, the federal agents and attorneys will have substantially more experience in proceedings like yours, and some of them are liable to hold senior positions in the offices of the Department of Justice or the Office of Inspector General. Unfortunately, this creates a definite disadvantage for you. However, by hiring a defense team of adept and peerless attorneys like the team of attorneys at Hasson Law Group LLP, you can ensure that the factors of education and experience are on your side.

3. Call out Fault Methods and Assumptions

Despite their broad experience in medical fraud investigations, prosecutors and agents with the Department of Justice, Office of Inspector General, and other agencies make an error like any other person. Additionally, in cases involving inspections triggered by RAC, ZPIC, and MAC audits, it is common for the auditor to have reached erroneous conclusions based upon inaccurate auditing assumptions and methodologies.

4. Search Relentlessly into the Provisions of the Federal Health Care Laws That Might Protect You

While the Anti-Kickback Statute, Stark Law, False Claims Act, and the many other laws the Department of Justice and Office of Inspector General use to target health care professionals are extraordinarily vast in scope, they are also liable to a variety of regulatory and statutory exceptions. For instance, the False Claims Act necessitates apparent proof of “specific intent to violate the law or… a consciousness that what [you were] doing was wrong,” to precipitate criminal culpability. Another case in point is the Anti-Kickback Statute’s bans on “remuneration” are subject to a long list of safe harbors that defend all sorts of compensation-based exchanges.

5. Recognize When Enough Is Enough

Even though cooperating with the government’s investigation may benefit you to an extent, you need to recognize when enough is enough as well. If you are overly-cooperative and you offer up incriminating information to federal agents, your readiness to assist with the investigation can lead to lead to more criminal prosecution instead of saving you from it.

Similarly, when the Office of Inspector General sends you a subpoena in the mail or when federal agents knock at your door, you know to recognize when the federal government is exceeding its authority. While the Department of Justice, the Office of Inspector General, and other federal agencies have broad investigatory authority, there are statutory, regulatory, and Constitutional limits to how far they are permitted to go.

6. Leverage the Facts (Or Even Lack Thereof)

Occasionally, the best defense is a good offense. While the government has the burden of proving your guilt beyond a reasonable doubt, when you have evidence that can show your innocence, you could stop the government in its tracks by asserting that innocence. However, if the facts are too complicated and the evidence to uphold charges doesn’t exist, this can be an advantage, as well as you can leverage these factors for a favorable outcome prior to charges being filed.

7. Keep It Civil

Lastly, if the government has proof against you and charges appear to be in your future, then it might be time to shift your attention to dropping the charges to the category of civil instead of criminal. The legal standards in criminal and civil cases differ in multiple ways. Keeping your case civil may improve the likelihood of negotiating a favorable settlement before trial as well as limiting your potential exposure. Despite the circumstances involved, if you are facing a federal medical fraud investigation, the worst solution is to do nothing. It’s crucial to protect yourself by whatever means necessary, and it starts with seeking experienced defense representation.

Hire an Atlanta Medical Fraud Attorney Today

We bring our prestigious large law firm and government service backgrounds to a small firm setting to offer you our extensive expertise in a personal, individualized approach where each case gets our full attention and our clients know they’re our priority. If your medical practice or business is under investigation by the Department of Justice, Office of Inspector General, or any other federal law enforcement agency, schedule a free and confidential case assessment with Hasson Law Group LLP at (678) 701-2869. We are proud to serve the Atlanta, Georgia area since 2013.

Contact Us

    contact us

    Hasson Law Group LLC

    The Hasson Law Group, LLP, is an Atlanta, GA law firm dedicated to two principal practice areas: winning high stakes disputes in the areas of business litigation, insurance recovery, and complex criminal defense, and tax, corporate and regulatory law mechanisms affecting family businesses, tax-exempt organizations and the individuals who support or serve them.

    Subscribe to our Newsletter